Why is carboplatin dosed as auc

Various formulas have been used to estimate renal function. The Cockcroft-Gault equation is the most common formula recommended by pharmaceutical manufacturers to determine drug dosages for patients with impaired renal function. Historically, the Gynecologic Oncology Group GOG used a different formula, the Jelliffe equation, to estimate creatinine clearance for carboplatin dosing. Both formulas were developed and validated using non-IDMS creatinine values. The MDRD formula has been re-expressed using the new IDMS creatinine values but cannot be used for carboplatin dosing as it has not been validated for this purpose.

Although the creatinine clearance is always slightly higher than the GFR, the two estimates of renal function are used interchangeably in the Calvert formula. This led to the publication of an action letter on guidelines for carboplatin dosing in October The Cockcroft-Gault equation was found to overestimate the creatinine clearance in obese patients or in patients with abnormally low creatinine values.

These concerns for patient safety led the GOG to make further recommendations for carboplatin dosing. Sabbatini, MD Saturday, September 1, Carboplatin-based chemotherapy remains the mainstay of treatment for many patients with gynecologic malignancies. They recommended capping the maximum carboplatin dose based on target area under the curve AUC. In patients with abnormally low serum creatinine they recommended using a minimum serum creatinine value of 0.

This indicates that an individual dosing strategy is warranted to obtain the optimal AUC. In this article, the development and application of a simple equation, known as the Calvert formula, are discussed. This formula can be used to calculate the carboplatin dose accurately in order to obtain a target AUC by using only the GFR. This formula has proven to be, in both retrospective and prospective studies, a reliable tool to calculate the optimal dose of carboplatin Future studies should determine the value of the creatinine clearance as a measure for the GFR.

Abstract Carboplatin is a chemotherapeutic agent frequently used in the treatment of various malignancies.